Critical identities

Key principles of critical theory — The conditions that made the health professions possible — The healthcare professions as gendered — Colonisation and healthcare — Healthcare and disability — Taking action — Critical theory and physiotherapy — Critiques of critical theory

Although Marx casts a long shadow over social theory in the 20th century, functionalism and ideas of social order dominated sociology until 1950. Things changed after World War II, however, with the emergence of a counter-culture movement created by a generation of young people who turned away from the conservative values of their parents. Feminism, civil rights, disability activism, gay liberation, anti-war protests, drug culture, investigative journalism, the contraceptive pill, university education, television, and rock and roll, instigated a radical and groundbreaking rupture in the social order of the rapidly advancing economies of Europe and North America. At the heart of this rupture was the rise of critical theory and its focus on questions of power. Critical theory brought to the surface the kinds of unequal ‘distribution of advantage’ that had blighted societies for generations ^[1]. It argued that structural power was rife in modern society, and that the advantages that some people in the West enjoyed perpetuated the exploitation of others.

In sociology, advocates of critical theory rejected the idea inherited from functionalism that social rules and values operated equally for everyone. Rather, critical theorists saw functionalism as mistakenly promoting the ‘moral integrity’ of the Enlightenment ^[2], and being ‘built on the gains of colonial conquest’, involving ‘violence and exploitation which utterly contradict and undermine Enlightenment ideals of rational progress towards greater prosperity’ ^[3].

Critical theorists asked how it could be that societies as supposedly sophisticated and enlightened as those in the West, could invent devices of mass destruction like the atomic bomb; could build modern empires that forced nearly half of the world’s population into servitude; could treat one entire gender as handmaidens and sex objects; and define anyone who was not an English-speaking, heterosexual, non-disabled, white man, as ‘other’.

The impact of this work on people’s consciousness of the world around them cannot be overstated. Over three decades after WWII, the world that had been the fantasy of empire-builders and social engineers, was shaken loose by a generation of activists and radicals that not only challenged every convention, but invented a whole new set of tools for analysis and critique.

There are many arms to critical theory, and many of these focus on the unique identities and voices of specific marginalised groups. There have also been many targets for critical theorists’ ire, not least the military, capitalists, the church, the police, the education system, industrial farmers, government, and the family. But the health professions have also come in for unprecedented critical scrutiny. Between 1960 and 1990, the health professions, and most especially medicine, was subject to a barrage of negative critical scrutiny that feels, in hindsight, like an insurgency or revolution. For the first time in its storied history, medicine was the object of withering critique, including claims of self-interest and abuse, anti-professional rhetoric and malpractice, cynicism towards its privilege and prestige, and the rejections of its claims to objectivity, detachment and value-neutrality.

This chapter unpacks some of this critique because many of the arguments made by critical theorists about medicine translate to physiotherapy. This is not surprising, perhaps because physiotherapy has always sought to reflect the language, culture, and practices of Western medicine. But there are some subtle and specific differences with physiotherapy too, and these need to be worked through if we are to make sense of critical theory and the lessons we can learn from it.

Before beginning, though, it is worth pointing out that, as with the last chapter, there is very little celebration of the beauty and splendour of physiotherapy here. Sometimes it is hard to read critical theory and see one’s profession subject to such antipathy. But ultimately, the spirit of critical theory is deeply positive because it is based on the idea of liberation: liberation from oppression, liberation from domination, and liberation from tyranny. In their recent paper on nursing, Kylie Smith and Thomas Foth remind us of Jean-Luc Nancy’s belief that ‘“a crisis is a period where something is revealed,” symptoms appear and reveal something about us, and it is this “moment of revelation that allows us to judge and to heal”’ ^[4]. To arrive at liberation, though, we have to understand how oppression, domination, and tyranny came to be part of health professional practice in the first place, and then what critical theorists argue we should do about it.